- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.20 / $2,663.12 / $3,625.00
| Facility | | $278.20 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.16 / $278.20 / $471.48
| Professional | | $150.16 | $278.20 | $471.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.71 / $2,376.00 / $8,498.00
| Facility | | $389.71 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.16 / $462.66 / $2,147.19
| Professional | | $192.16 | $462.66 | $2,147.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.91 / $251.74 / $475.70
| Facility | | $195.91 | $251.74 | $475.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.00 / $435.21 / $802.31
| Professional | | $268.00 | $435.21 | $802.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.85 / $401.13 / $785.26
| Professional | | $205.85 | $401.13 | $785.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.20 / $357.24 / $6,679.00
| Facility | | $167.20 | $357.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.38 / $425.04 / $591.71
| Professional | | $348.38 | $425.04 | $591.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.46 / $448.18 / $874.48
| Professional | | $212.46 | $448.18 | $874.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.17 / $492.17 / $492.17
| Professional | | $492.17 | $492.17 | $492.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.19 / $3,372.00 / $16,394.00
| Facility | | $836.19 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.00 / $618.34 / $2,147.19
| Professional | | $332.00 | $618.34 | $2,147.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.60 / $473.41 / $966.30
| Professional | | $320.60 | $473.41 | $966.30 |